Lion Advantage Flex Plan
This plan is specifically for faculty, staff, and postdoctoral appointees who may already be enrolled in Medicare, or employees enrolled in Tricare or other health insurance. Keep in mind that if you will be turning age 65 in calendar year 2025 and enrolling in Medicare, you may want to also consider this plan option.
The Lion Advantage Flex plan is a high deductible health plan option with a lower employee contribution, which DOES NOT pair with a Health Savings Account (HSA).
Guidelines for participation in this plan:
- CANNOT have a J or F Visa; these Visa holders are eligible for the Lion Traditional plan only.
- CANNOT be classified as a Technical Service employee.
- CANNOT have a spouse enrolled in a Health Savings Account (HSA).
- If you are the Penn State employee and your spouse is employed elsewhere and enrolled in a high-deductible health plan with an HSA, a Health Care FSA cannot be opened by either employee. The IRS does not permit use of a Health Care FSA when contributing to an HSA.
Faculty, Staff, and Postdoctoral Scholars enrolled in this plan are also able to enroll in the pre-tax Health Care Flexible Savings Account (FSA) to help with medical expenses and reduce your tax liability, keeping in mind the above participation guidance. Please note that Postdoctoral Fellows are ineligible to participate in a FSA.
Below are details regarding the plan design. For more information regarding payroll contributions examples please use the Healthcare Calculator.
2026 Lion Advantage Flex Plan Design
Highmark Blue Shield continues as the medical services plan administrator.
In-Network Deductible
| Individual Coverage | Family Coverage | |
|---|---|---|
| Deductible | $1,700 | $3,400 |
Coinsurance Maximum = In-network coinsurance percentage = 10%
| Individual Coverage | Family Coverage | |
|---|---|---|
| Coinsurance Maximum | $1,975 | $3,950 |
In-Network Out-of-Pocket Maximum (Deductible + Coinsurance Maximum)
| Individual Coverage | Family Coverage | |
|---|---|---|
| Total Out-of-Pocket Maximum | $3,675 | $7,350 |
In-Network Services
| Coverage | |
|---|---|
| Preventive Care Highmark Preventive Schedule | Covered at 100% |
| Office Visit | Deductible and Coinsurance apply |
| Well360 Virtual Health (Telemedicine) | Faculty, Staff, Postdoctoral Appointee $0 BEFORE Deductible Technical Service $0 AFTER Deductible |
| Specialist | Deductible and Coinsurance apply |
| Urgent Care | Deductible and Coinsurance apply |
| Emergency Room (waive if admitted) | Deductible and Coinsurance apply |
2026 Lion Advantage Flex Prescription Coverage
CVS Caremark will begin as our prescription coverage administrator beginning January 1, 2026.
All medication cost will be owed until plan deductible has been met. After deductible has been met, the below coinsurance amounts will apply.
| Medication Type | Generic Medications | Preferred Brand Medications | Non-Preferred Brand Medications |
|---|---|---|---|
| Preventive Medications CVS Preventive Drug List | 10% Coinsurance | 20% Coinsurance | 40% Coinsurance |
| Retail Pharmacy (31-day supply or less, picked up at an in-network retail pharmacy) | 10% Coinsurance | 20% Coinsurance | 40% Coinsurance |
| Retail 90 (83-day supply or less, picked up at in-network retail pharmacy) | 10% Coinsurance | 20% Coinsurance | 40% Coinsurance |
| Retail 90 (84-day supply up to 90-day supply, picked up at in-network retail pharmacy) | 10% Coinsurance | 20% Coinsurance | 40% Coinsurance |
| Mail Order (90-day or less supply, mailed to home from CVS mail order pharmacy) | 10% Coinsurance | 20% Coinsurance | 40% Coinsurance |
| Specialty | 20% Coinsurance, $65 Minimum | 20% Coinsurance, $65 Minimum | 40% Coinsurance, $100 Minimum |
| CVS ACA Preventive Drug List | 0% Coinsurance |
|---|
Payroll Premium Contributions
Monthly premium contributions - Lion Advantage HSA or Lion Advantage Flex Plan
| Coverage | Salary % | $30,000 | $40,000 | $55,000 | $75,000 | $85,000 | $100,000 | $140,000 | $175,000 | $200,000 |
|---|---|---|---|---|---|---|---|---|---|---|
| Individual | 0.92% | $23.00 | $30.67 | $42.17 | $57.50 | $65.17 | $76.67 | $107.33 | $134.17 | $153.33 |
| Two-Person | 2.23% | $555.75 | $74.33 | $102.21 | $139.38 | $157.96 | $185.83 | $260.17 | $325.21 | $371.67 |
| Parent/Child(ren) | 2.06% | $51.50 | $68.67 | $94.42 | $128.75 | $145.92 | $171.67 | $240.33 | $300.42 | $343.33 |
| Family | 2.83% | $70.75 | $94.33 | $129.71 | $176.88 | $200.46 | $235.83 | $330.17 | $412.1 | $471.67 |
Lion Advantage Flex - Detailed Coverage Chart
Lion Advantage Flex - Summary of Benefit Coverage (SBC)
Lion Advantage Flex - Highmark Coverage Booklet
Coming soon
COVID-Related Testing
COVID-related testing is not covered at 100% and will be subject to deductible and coinsurance under the Penn State medical plans.
We strongly encourage you to discuss with your physician the financial impact of any COVID testing that may be prescribed – certain tests can cost ~$1,500 or more, which will apply to your deductible and/or coinsurance amounts for the plan year.
One such test is Procedure Code (CPT) 0202U, which is a medical procedural code to detect multiple respiratory pathogen targets and is performed in the provider’s office. For example, instead of this costly test, you can avoid significant out of pocket costs by using an at-home COVID test. Your physician will make an appropriate recommendation based on your own health needs; however, you should be aware and discuss the cost implications before having a test.
Employees can contact the Penn State Highmark concierge customer service team at 844-945-5509 with further questions.